Think Tank

HEALTH EQUITY AND DESIGN:

Using Architecture to Combat Disparities in Healthcare Access

Architects and communities can come together to overcome disparities in healthcare access

Sepideh Asadi, AIA, WELL AP

“Your zip code is a better predictor of your health than your genetic code,” said biostatistician Melody Goodman.1 Extensive research has been done on the social determinants of health, which the World Health Organization defines as “the non-medical factors that influence health outcomes.”2 Social determinants such as racist policies, a history of segregation, and decades of neighborhood disinvestment have led to poor health outcomes and inequities, especially in socially and economically deprived communities.3

A growing awareness of social determinants has initiated innovative forms of health practice and policies. Research done by PolicyLink suggests that “improving individual medical treatment, increasing access to culturally competent health services, and effective disease prevention strategies” are some solutions to understand and address disparities.4

PolicyLink authors suggest that communities are central to this new thinking and action. The places where people live can hinder or contribute to good health. The appreciation of a community’s influence on health has, for example, made community organizing a key strategy of some local clinics and public health departments. Epidemiologists are moving toward measuring the influence of neighborhoods and social capital [i.e., features of social organization that facilitate cooperation for mutual benefit ] on health outcomes.5

Illinois’ Waukegan, a city where the population has dropped by 1.6% from 2010 to 2017, exemplifies the effects of low-income residents suffering disproportionately from adverse health outcomes.6 A high property tax burden, low wages, and lack of health insurance led to a lack of investment.7 With the belief that healthcare is a human right, Chicago-based Erie Family Health Centers took the opportunity to purchase and transform a 24,000-square-foot, 40-year-old bank into a bright, welcoming community center. This adaptive reuse project, located within a commercial strip in the heart of Waukegan, is surrounded by residents and easily accessed by public transportation.

Today, the Erie HealthReach Waukegan Health Center serves Lake County residents regardless of their ability to pay. It stands as a role model for how equitable practice can be celebrated by architectural design. The facility encourages a sustainable and socially cohesive community built on bonds that unite rather than differences that separate.

This example also demonstrates the integration of evidence-based practices and design thinking into innovative healthcare processes. The addition of a grand open stair in the facility inspires both staff and patients to choose the healthier option and take the stairs rather than the elevators.

Making healthier choices is dependent on fair and just opportunity and access to the care. This leads to the concept of health equity, which posits that every individual should be able to live a healthy life regardless of their background. According to CDC, health equity is when each person has chance to reach their “full health potential,” without facing obstacles from “social position or other socially-determined circumstances.”8 It should be emphasized that health equity is not the same as health equality. Planning based on the health equity concept assures that everyone meets their needs appropriate to their unique situation rather than providing a one size fits all solution.

The Robert Wood Johnson Foundation has developed a Culture of Health framework, in which health equity sits at its center. They describe this as follows: “To build a Culture of Health, we must first ensure everyone has the basics to be healthy. And when it comes to expanding opportunities for health, thinking the same approach will work universally is like expecting everyone to be able to ride the same bike.”9

Waukegan’s Lake Behavioral Hospital is an example of a design that contributes to a more widespread sense of belonging within the community. In 2017, behavioral healthcare organization US HealthVest invested in revitalizing a 30-year-old vacant medical office building on the former Vista Medical Center West campus. Many Waukeganites embraced the transformation of the campus known locally as “the old St. Therese Hospital” into a facility dedicated exclusively to mental health and addiction treatment. The resulting retrofit not only addresses the health disorder treatment needs, but also could trigger a rejuvenation of the entire campus.

“The new and much larger facility has allowed us to provide additional services to more people,” said Lake Behavioral Hospital CEO Cindy DeMarco. “Compared to the old facility, the new spaces are much more spread out so patients can move around in a calming environment full of light.”

Healthcare frameworks should recognize that patients are people—people with concerns that often overshadow their wellbeing status. Circumstances like unemployment, failing grades, and housing instability can all affect the mind’s wellbeing just as much as poor diet and exercise can affect the body. This improved understanding of wellness reaffirms that health equity lies beyond the traditional medical practice setting. Health organizations must join forces with community agencies to build reliable resources based on trusted relationship, understanding, and transparency. Working together can not only engage patients more effectively in health where they live and work, but it can also indirectly mitigate factors that contribute to significant illness and disability.10

Although disparities in health outcomes by race/ethnicity or income status are persistent and difficult to reduce, recognizing these social factors should ultimately be seen as a motivation and not discouragement. Our sense of comfort and belonging is strengthened by positive contact with our neighbors and involvement in decisions about the spaces we share. We may feel overwhelmed by the scale and complexity of health inequities, but we must reflect on who we are and how our skills, tools, and experiences can bring value.

This consolidation of talent can unleash the creativity of communities and achieve the true meaning of equity, characterized by a focus on personalization instead of delivering consistent care.

Sepideh Asadi, AIA, WELL AP is a licensed architect with Legat Architect in Oak Brook, Illinois. She currently lives in Oak Park, where she is a neighbor of Frank Lloyd Wright. She believes that designers need to create spaces where everyone can cherish their moments together, regardless of their differences.

1. Roeder, A. R. (2014, August 4). Zip code better predictor of health than genetic code. https://www.hsph.harvard.edu/news/features/zip-code-better-predictor-of-health-than-genetic-code/

2. “Social Determinants of Health.” https://www.who.int/westernpacific/health-topics/social-determinants-of-health.

3. Fedorowicz, Martha, et al. n.d., Leveraging the Built Environment for Health Equity

4. Reducing Health Disparities Through a Focus on Communities. (2002, November). PolicyLink.

5. MacArthur SES & Health Network | Research. (n.d.). University of California San Francisco.

6. U.S. Census Bureau

7. Hanlon, B. (2012). Once the American Dream: Inner-Ring Suburbs of the Metropolitan United States. Temp

8. Health Equity | CDC. (n.d.). Center for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/healthequity/index.htm

9. The Robert Wood Johnson Foundation (RWJF). (2019, July 26). Visualizing Health Equity: One Size Does Not Fit All Infographic. RWJF. https://www.rwjf.org/en/library/infographics/visualizing-health-equity.html

10. Wong , W. F., LaVeist, T. A., & Sharfstein, J. M. (n.d.). Achieving Health Equity by Design.